Provider Demographics
NPI:1689429946
Name:LIBERTY PHARMACY INC
Entity type:Organization
Organization Name:LIBERTY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAWWAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-952-6005
Mailing Address - Street 1:886 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2732
Mailing Address - Country:US
Mailing Address - Phone:203-952-6005
Mailing Address - Fax:
Practice Address - Street 1:886 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2732
Practice Address - Country:US
Practice Address - Phone:203-952-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-20
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy